Provider Demographics
NPI:1649272550
Name:FLANDERS, INGRID (FNP)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:FLANDERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:ANN
Other - Last Name:STUEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3360 NE 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2811
Mailing Address - Country:US
Mailing Address - Phone:541-991-0171
Mailing Address - Fax:
Practice Address - Street 1:3360 NE 133RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2811
Practice Address - Country:US
Practice Address - Phone:541-991-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350092NP363LF0000X, 363LP2300X
WAAP30006571363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q20591Medicare UPIN
101001Medicare ID - Type Unspecified